Shady Grove Insurance Hell

[Anonymous]

So, my insurance company insists that I have coverage but that it is waiting for Shady Grove to fill out prior authorization paperwork, which they apparently haven't done. My on-line pharmacy tells me that they have been told the same thing by my insurance company. But, my Shady Grove nurse and financial coordinator tell me that I have no coverage and there is nothing they can do - no response about why they can't or haven't done the prior authorization. My insurance company tells me that it is their responsibility to fill submit the prior authorization paperwork and that I shouldn't have to do anything.

So what to do? I've gone around in circles with all 3 parties multiple times. Everyone I've talked to a Shady Grove passes the buck. Any advice on how to cut through this mess?

So much for keeping my stress levels down prior to treatment, huh?

[Anonymous]

check your insurance to make sure your docs are part of network- if they are - good- then go on to your infertility coverage- is there a procedure to get it? most hvae it- i learned it the hard way- once with my clinic who was not covered thankfully got stuck with costs- the other was my ivf clinic was covered but i had to follow "infertility coverage" procedures for my insurance company- it may be your insurance company not putting the ok- try again- and welcome to IF insurance- but you can get this stress over with.. I remember crying so much and it just worked out- but it was a LOT of work..

[Anonymous]

Can you go into the SG finance coordinators office and call your insurance together? That way they can hear what your insurance is telling you vs. what they say they have been told. I know in Annandale you can just walk in and talk to the coordinator whenever you are there for an appointment.

[Anonymous]

I definitely recommend you either set up a 3-way call with Shady Grove and your insurance company or you go to the Shady Grove financial coordinators' office and make them call the insurance company with you in the room. Are you sure they have all the correct insurance information? Could it be that they are looking at your insurance company's coverage, but it is your husband's (i.e., secondary insurance) that has the infertility coverage? They can deal with this, but it could cause some confusion if it is not clear. Also, it may be helpful to ask to speak to the insurance coordinators' supervisor. The coordinators are divided up by insurance company -- for example there is one person responsible for United Healthcare, one person for Blue Cross, etc. Perhaps they have the correct company but the wrong plan? In all my dealings with Shady Grove dealing with my various insurance companies over the past 6 years, they have always been very responsive and pro-active. In fact they kept abreast of changes with my insurance plan and informed me when my insurance company started requiring me to deal with a specific mail order pharmacy. They were very quick to set up everything and get my meds out to me. In another instance, my primary care physician's office was unfamiliar with the hoops required to go through to fill out the referral to shady grove -- shady grove was kind enough to deal directly with the PCP office and help them fill out the paperwork and work with the insurance company so that I could get my referral.

[Anonymous]

OP here. Thanks for the responses. Sounds like the insurance coordinator in the D.C. office isn't doing his job. I talked to him about this, but he just gave me a vague answer, never volunteered to call my insurance company (with or without me), and didn't tell me that there was someone in the Rockville office who was responsible for my insurance company, even though I asked, and gave me the impression that this was my nurse's problem to deal with. There is just an utter lack of responsiveness in the D.C. office. I finally did track down the person in charge of my insurance company in Rockville and she reluctantly agreed to submit the paperwork. I really don't know if they are just lazy or if it costs them too much money, but they are acting like I'm asking them to go above and beyond the call of duty to send information that my insurance company is requesting. Terrible corporate culture.

[Anonymous]

Why doesn't Shady Grove contact your insurance company directly (usually the 1 800 phone # is listed on the card)?

It is also odd that Shady Grove isn't filling out the paperwork. They usually do irregardless of whether or not the claim will be cleared/paid by the insur. company (the "it's worth a try" concept).

Keep pestering...the squeaky wheel gets the grease.

[Anonymous]

In my experience with Shady Grove, it sounds like they are wrong. They tried to bill me twice! After my insurance paid and I paid all the deductibles/copays. The financial consultant couldn't even read their own form properly.

Your insurance company needs some sort of pre-authorization form from them to dispense the meds/etc. Shady Grove should be able to fax this to them. I had a similar snafu more recently with Columbia--but it all that was needed was a simple fax form.

Isn't it maddening--on top of all the other stress!

Good luck.

[Anonymous]

Isn't the pre-authorization paperwork fairly standard and routine...so it is mind boggling why Shady Grove is dragging their feet. It isn't like you are asking them to reshingle your roof!

Hope this gets resolved for you soon...as if you really need this right now.

[Anonymous]

I know who you are talking about in DC and h_te him! He gives me vague answers also and never knows what he is talking about. I got on the phone with the FC from Rockville and told her how terrible I thought he was. So now I deal with her. Definitely find someone at Rockville that will listen. He shouldn't be employed by them.